- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.69 / $60.00 / $64.00
| Facility | 26 | $9.69 | $60.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.90 / $73.34 / $300.00
| Professional | | $25.90 | $73.34 | $300.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.83 / $15.80 / $60.00
| Professional | 26 | $8.83 | $15.80 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.23 / $63.97 / $240.00
| Professional | TC | $14.23 | $63.97 | $240.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.65 / $10.30 / $17.38
| Professional | 26 | $8.65 | $10.30 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.70 / $32.85 / $51.67
| Professional | | $28.70 | $32.85 | $51.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.16 / $14.19 / $17.64
| Professional | 26 | $11.16 | $14.19 | $17.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.64 / $20.14 / $34.27
| Professional | TC | $17.64 | $20.14 | $34.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.56 / $9.25 / $9.86
| Professional | 26 | $8.56 | $9.25 | $9.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.15 / $24.96 / $92.15
| Professional | | $15.15 | $24.96 | $92.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.84 / $10.28 / $17.55
| Professional | 26 | $5.84 | $10.28 | $17.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.10 / $14.89 / $34.38
| Professional | TC | $9.10 | $14.89 | $34.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.22 / $28.15 / $130.60
| Professional | | $18.22 | $28.15 | $130.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.78 / $10.42 / $17.05
| Professional | 26 | $7.78 | $10.42 | $17.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.08 / $15.35 / $107.60
| Professional | TC | $11.08 | $15.35 | $107.60 |